Provider Demographics
NPI:1487800231
Name:MARSHALL, JENNIFER JOAN (DDS, MSD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:JOAN
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7610 N LA CHOLLA BLVD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85741-4201
Mailing Address - Country:US
Mailing Address - Phone:520-544-8522
Mailing Address - Fax:
Practice Address - Street 1:7610 N LA CHOLLA BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-4201
Practice Address - Country:US
Practice Address - Phone:520-544-8522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-13
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD52571223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry